Finite mixture models with concomitant information: assessing diagnostic criteria for diabetes

The World Health Organization (WHO) diagnostic criteria for diabetes mellitus were determined in part by evidence that in some populations the plasma glucose level 2 h after an oral glucose load is a mixture of two distinct distributions. We present a finite mixture model that allows the two component densities to be generalized linear models and the mixture probability to be a logistic regression model. The model allows us to estimate the prevalence of diabetes and sensitivity and specificity of the diagnostic criteria as a function of covariates and to estimate them in the absence of an external standard. Sensitivity is the probability that a test indicates disease conditionally on disease being present. Specificity is the probability that a test indicates no disease conditionally on no disease being present. We obtained maximum likelihood estimates via the EM algorithm and derived the standard errors from the information matrix and by the bootstrap. In the application to data from the diabetes in Egypt project a two-component mixture model fits well and the two components are interpreted as normal and diabetes. The means and variances are similar to results found in other populations. The minimum misclassification cutpoints decrease with age, are lower in urban areas and are higher in rural areas than the 200 mg dl^-1 cutpoint recommended by the WHO. These differences are modest and our results generally support the WHO criterion. Our methods allow the direct inclusion of concomitant data whereas past analyses were based on partitioning the data.     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Internalized Other Interviewing in Relational Therapy: Three Discursive Approaches to Understanding its Use and Outcomes

For over 20 years, family therapist Karl Tomm has been engaging families and couples with a therapeutic intervention he calls Internalized Other Interviewing (IOI). The IOI (cf. Emmerson‐Whyte, 2010; Hurley, 2006) entails interviewing clients, from the personal experiences of partners and family members as an internalized other. The IOI is based on the idea that through dialogues over time, one can internalize a sense of one's conversational partner responsiveness in reliably anticipated ways. Anyone who has thought in a conversation with a family member or partner, “Oh there s/he goes again,” or anticipates next words before they leave the other's mouth, has a sense of what we are calling an internalized other. For Tomm, the internalized anticipations partners and family members may have offers entry points into new dialogues with therapeutic potential—particularly, when their actual dialogues get stuck in dispreferred patterns.     

Associations of Marital Conflict With Emotional and Physiological Stress: Evidence for Different Patterns of Dysregulation

The goal of this study was to explore theoretically suggested but untested links between interparental conflict and stress physiology in late adolescence. A multi‐method study was conducted involving families (n = 42) who previously participated in the University California, Irvine site of the NICHD Study of Early Child Care and Youth Development; adolescents were 17½ years of age on average. Parent report and observer ratings of conflict, adolescent participation in a robust social‐evaluative stressor, and assessment of cortisol, cardiovascular, and emotional functioning were included. Marital conflict was associated with dampened physiological stress responses in adolescence but sensitized emotional responses, suggesting that conflict may be associated with problems integrating and coordinating emotional and physiological responses to stress.     

Ex Ante Project Evaluation and the Complexity of Early Decision-Making

This paper looks beyond more traditional evaluation activities to focus primarily on evaluation up front. It suggests that the early appraisal of an investment case or a project should apply essentially the same evaluation criteria that will be used in ex post evaluation, and thus increase the likelihood of a successful project outcome. However, the initial plan might be altered as result of subsequent analysis, assessment, negotiation, positioning, and the exercise of power. The last part of this paper presents an empirical study of 23 projects, which examines the complexity of processes that occur in the idea- and decision phases.     

Using Objectification Theory to Examine the Effects of Media on Gay Male Body Image

Research has increasingly noted that gay male adults are more at risk for developing body image dissatisfaction than other male populations. Body image issues warrant attention, particularly since they have been connected to the development of disordered eating patterns. Studies have often traced gay male body dissatisfaction to various sociocultural elements and phenomena, particularly the media. In fact, various media genres have been implicated as being instrumental in propagating idealized male physiques, which in turn may negatively influence observers. Using objectification theory, this paper aims to review the process by which media imagery are internalized by some gay men and how such internalizations harmfully impact their body image. The clinical implications and treatment of body dissatisfaction will be reviewed in terms of social work practice with gay male populations.     

HPV vaccine acceptance among a sample of Southern men who have sex with men: A comparison of younger and older men

Objectives: Do short, online educational messages about the human papillomavirus (HPV) influence younger and older men who have sex with men (MSM) differently? Second, what are the HPV knowledge levels and risk perceptions of Southern MSM living outside of major metropolitan areas? Methods: This study draws on participants who completed an anonymous online survey asking about their knowledge, risk assessment, and vaccine acceptance regarding HPV. Results: Knowledge about HPV was low among the MSM in this study. After reading a one-page information intervention, vaccine acceptability increased by a statistically significant amount among both a Younger and Older cohort but risk perception only increased among the younger respondents. Single men regardless of age cohort reported sharper increases in perceived risk after the intervention, but relationship status did not produce significant differences in vaccine acceptability. Conclusion: Online, brief interventions may be effective means of increasing motivation to vaccinate among Southern MSM.     

Financial Reporting Lags in the Non-profit Sector: An Empirical Analysis

We examine financial reporting lags among a large sample of Belgian non-profit organizations (NPOs). Doing so, we add to the literature on financial reporting and accountability in the non-profit sector. Next to drivers of the financial reporting lag that have been identified in prior studies based on private firms (e.g., delaying the disclosure of bad news), we find that the way of funding the NPO (i.e., reliance upon donations and/or grants) and its specific area of activity are significantly related to the financial reporting lag. Our results also suggest that important changes in accounting regulation significantly delay the financial reporting process. Importantly, we note that 17.2 % of the sample organizations do not file their financial statements within the legal time span.